F O C U SFocusing on the people and initiatives that distinguish Christiana Care Health System

N O V E M B E R 2 0 1 3V O L U M E 2 4 , N U M B E R 1 1

A publication of Christiana Care Health System External Affairs

CONTINUED P. 2

I N T H I S I S S U E :

6 GRANT FUNDS DELAWARE RESEARCH PARTNERSHIP > $28.3 million in funding will support clinical and translational research

7 TRAINING PHYSICIAN LEADERS > LEED-R course trains residents, fellows for leadership roles

15 MARKETPLACE GUIDES > Christiana Care helps neighbors understand insurance options

Ten years ago, the Christiana Care Cancer Program made a transformational leap forward in the delivery of quality, value-driven cancer care and services to our community. In only a decade, Christiana Care has established the Helen F.

Graham Cancer Center & Research Institute as a national leader in comprehensive, multidisciplinary cancer treatment, services and research.

“What we do isn’t just a job to us; it is our vocation,” said Bank of America endowed and founding Medical Director Nicholas J. Petrelli, M.D. “We celebrate the lives and the experience of the many who have come to us for care and treatment, but our focus is on the greater challenge — ending the specter of cancer.”

The work of a decade has made an impact in numbers and lives. Cancer mortality rates in Delaware are falling at twice the national average. Before the Graham Cancer Center opened, Delaware had the second highest cancer mortality in the nation. Today it is 14th. Cancer rates also are declining, thanks in part to advances in cancer treatment and technology, and thanks to collaborations on cancer screening and prevention with other Delaware hospitals, providers, state government and community outreach groups.

Helen F. Graham Cancer Center & Research Institute celebrates a decade of transformational cancer care

The Christiana Care Way We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value.

See article on page 3.

Helen F. Graham Cancer Center & Research Institute leadership team (from left) Patrick Grusenmeyer, Sc.D., FACHE, Nicholas J. Petrelli, M.D., and William Holden, MBA, RN, RT (T), (R).

2 ● F O C U S N OV E M B E R 2 0 1 3

In 2007, the National Cancer Institute (NCI) selected the Helen F. Graham Cancer to serve as an NCI-selected com-munity cancer center program (NCCCP), launching Christiana Care into a top national network working together to bring the latest cancer treatments to patients in their own communities. Today, the Graham Cancer Center ranks among the country’s top five NCCCPs, recognized as a model for cancer treat-ment, research and supportive care.

Multidisciplinary careEven before 2003, Christiana Care’s Cancer Program was advocating for cancer patients, their caregivers and families, citing a pressing need to make the best available care easily accessible. Before construction began on the state-of-the-science facility that would become the Helen F. Graham Cancer Center & Research Institute, multidisciplinary, disease-specific treatment centers (MDCs) tailored to every type of cancer

were already taking shape. MDC confer-ences bring patients face-to-face with a complete team of specialists needed to begin therapy, all in one visit. A surgeon, medical oncologist, radiation oncologist, geneticist, health psychologist, nurse navigator, subspecialists and support staff all participate to help the patient map out a personalized treatment plan.

Nurse navigators

Since the earliest days of the Helen F. Graham Cancer Center & Research Institute, the nurse navigator program has been a signature service to patients.

H E L E N F . G R A H A M C A N C E R C E N T E R & R E S E A R C H I N S T I T U T E

CONTINUED

Research benefits patients today and tomorrow

Christiana Care’s cancer research program is one of the largest among community-based hospitals in the country, with some 120 active clinical trials in every kind of cancer. Christiana Care was third in the nation last year for patient enrollment in clinical trials. These trials can be a patient’s best opportunity for treatment; studies show survival rates and outcomes are better when patients participate in a clinical trial.

The NCI-funded Christiana Care Community Clinical Oncology Program (CCOP) is one of the top enrollers in cancer clinical trials in the newly formed Alliance of Clinical Trials in Oncology.

Brenda Rabeno, MLS, MBA

Multidisciplinary cancer specialists meet regularly to plan patient care.

Latonya Mann, RN, OCN

N OV E M B E R 2 0 1 3 F O C U S ● 3

Christiana Care nurse navigators have helped more than 70,000 patients with some 650,000 individual support services. Graham Cancer Center staff provide training and consultation to help cancer centers around the country emulate this successful program.

Radiation oncology

The Radiation Oncology Department serves patients at three locations in Delaware and Maryland, offering advanced technology and leading experts directing care and treatment. A fourth site will open in 2014 on U.S. 202 in Concordville, Pa.

Christiana Care radiation oncologists adapt the latest imaging and treatment advances into clinical practice, including:

• A new training program in medical physics.

• Image-guided intensity modulated radiation therapy (IGRT/IMRT) stereotactic radiosurgery.

• High-dose-rate brachytherapy to treat gynecologic, skin and breast cancers.

The Graham Cancer Center is also home to Delaware’s first and only CyberKnife robotic radiosurgery system, which targets hard-to-treat tumors in the brain, lung and spine with pinpoint accuracy.

Hematology/Oncology

The inpatient Hematology/Oncology Unit at Christiana Hospital offers 24-hour care and support for cancer patients and includes a specialized unit for patients in the Bone Marrow/Stem Cell Transplant Program. This program, which celebrated its 17th anniversary in August, is recognized by the National Marrow Donor Program as a performance leader and accredited as an Apheresis Collection Center, Bone Marrow Collection Center and Bone Marrow Transplant Center.

Care management and supportSocial workers, nurse navigators, financial assistants, registered dieticians, genetic counselors, health psychologists, pain and rehabilitation specialists, and wellness coaches are all part of Christiana Care’s award-winning Cancer Care Management team. They offer assistance, encouragement and support to patients along the entire cancer care continuum.

The Graham Cancer Center was first in Delaware to offer specialized physical and occupational therapy for patients living with cancer. The oncology rehabilitation center has an experienced group of professionals under the direction of Lisa Marshall, OTR-L, who continually work to improve quality of life for cancer patients.

The Graham Cancer Center’s survivorship program was among the nation’s first and is widely recognized for innovation in supporting patients through life beyond cancer.

The Breast Center The Christiana Care Breast Center is the only facility in the region to offer leading-edge breast cancer care, from diagnosis to treatment, all under one roof. The Breast Center offers 3D mammography, the latest breast cancer screening and diagnostic technology, and the only dedicated breast MRI unit in the region.

The Center for Translational Cancer Research

In the West Pavilion of the Graham Cancer Center, the 7,000 square-foot Center for Translational Cancer Research (CTCR) is where scientists are solving research riddles in the lab that translate into better treatments for cancer patients at the bedside. The program is in collabo-ration with the University of Delaware, the Wistar Institute in Philadelphia and Delaware State University.

Researchers include:

• Bruce Boman, M.D., Ph.D., MSPH, FACP, director of Cancer Genetics and Stem Cell Biology at the CTCR, whose published research identifies a new marker for colon cancer stem cells.

H E L E N F . G R A H A M C A N C E R C E N T E R & R E S E A R C H I N S T I T U T E

CONTINUED

Sunjay Shah, M.D., and Karen Karchner, RN, OCN

Frank Beardell, M.D., and Donna Kerr, RN, BSN,examine a patient on the Bone Marrow Transplant Unit.

Swati Pradhan-Bhatt, Ph.D., and Robert Witt, M.D.

4 ● F O C U S N OV E M B E R 2 0 1 3

H E L E N F . G R A H A M C A N C E R C E N T E R & R E S E A R C H I N S T I T U T E

• Robert Witt, M.D., director of the Multidisciplinary Head & Neck Cancer Center, and molecular biologist Swati Pradhan-Bhatt, Ph.D., Graham Cancer Center director of Tissue Engineering, who are developing laboratory-engineered salivary-gland tissues that could eventually lead to artificial implants for patients who suffer complications from radiation treatments.

• Molecular biologist Jennifer Sims-Mourtada, Ph.D., CTCR’s senior research scientist, who is tracking a protein linked to aggressive breast cancer. Her efforts to identify why some cancers are resistant to treatment could aid development of more individualized therapies and less-invasive preventive approaches.

Pharmaceutical clinical trialsA robust pharmaceutical trials program is conducting Phase I and Phase II drug trials in collaboration with private indus-try and university research centers across the country. Many of these studies give our patients the opportunity for leading-edge cancer treatments, tailored to their particular cancer. Examples include trials for advanced breast cancer, the largest ever anti-cancer vaccine trial for non-small-cell lung cancer and the very first gene therapy trial in Delaware that targets melanoma.

Tissue procurementChristiana Care’s Tissue Procurement Center has provided research-quality biospecimens for the Cancer Genome Atlas Project since 2009, supporting the work of scientists to unlock the genetic secrets of cancer’s origins and vulnera-bility. Exciting results have emerged, including the discovery of four geneti-cally different subtypes of breast cancer in the largest, most comprehensive breast cancer genomic study to date.

The National Cancer Institute selected the Graham Cancer Center to be a Cancer Genome Atlast Project collection

training facility for university programs across the United States.

The center also processes biospecimens for the Wistar Institute and the CTCR for melanoma, ovarian, head and neck, lung, breast and colon cancer research.

Outreach and preventionUnder the direction of Nora Katurakes, RN, MSN, OCN, manager of Community Health Outreach and Education, the cancer center offers screenings for early detection of skin, prostate, breast, cervical and colorectal cancers, as well as combi-nation screening for heart, diabetes and other cancer risks. At the same time, the team provides education about cancer prevention and healthy behaviors. Partnerships through the Delaware Cancer Prevention and Control Program’s Screening for Life and others have broadened access to health screenings.

In April 2013, the Journal of Clinical Oncology published an article co-authored by Katurakes and Medical Oncologist Stephen Grubbs, M.D., a member of the Delaware Cancer Consortium, showing that overall colorectal cancer incidence in Delaware from 2002 to 2009 declined and closed the gap between African-American and white patients, saving $8.5 million in health care costs through earlier cancer detection and lower incidence.

Friends of the Helen F. Graham Cancer CenterThe Friends of the Helen F. Graham Cancer & Research Institute have been outstanding partners in helping us care for our neighbors by working to raise funds and awareness for the treatment and prevention of cancer. “Without their support, many of our programs and

technologies would not have been possible,” Dr. Petrelli said. The Friends have raised more than $2 million over the past decade to support research, technologies, patient care services, and education and screening programs at the Graham Cancer Center.

The future of cancer careToday’s Helen F. Graham Cancer Center is oriented toward providing patients with the best possible care in the present, and developing the tools to ultimately win the fight against cancer. Current goals include:

• Expanding screening, genetic counsel-ing and prevention programs to reach all of our neighbors, especially those at highest risk for cancer.

• Ensuring the Center for Translational Cancer Research is a premier site for the synthesis of ideas, technologies and research focused on preventing and curing cancer.

• Strengthening partnerships and forging new ones to speed cancer research, treatment and prevention through clinical trials.

• Supporting the work of the CTCR and other research centers around the country with the biospecimen resources provided by the Tissue Procurement Center.

• Fostering the development of a Delaware Center for Cancer Biology, where physicians and scientists can exchange ideas and work together on cancer’s challenges.

“The future of cancer medicine is closely linked to the ongoing transformation of our vision into the reality of delivering patient-centered, value-based cancer care,” Dr. Petrelli said. ●

CONTINUED

The gardens and labyrinth help create a healing environment at the cancer center.

N OV E M B E R 2 0 1 3 F O C U S ● 5

T H E C H R I S T I A N A C A R E W A Y

All new parents are deeply concerned about the health of their babies.

Moms and dads with babies who need extra care in the Neonatal Intensive Care Unit face lots of additional challenges. It’s scary for parents, who might already have had the trauma of a difficult pregnancy or a baby who was born sooner than expected.

Christiana Care has one of the highest-volume NICUs in the nation, caring for about 1,000 babies each year. Christiana Hospital is the only delivering hospital in Delaware offering Level III neonatal intensive care, caring for the smallest and sickest babies in the area.

Many of the newborns we care for may only need observation for a couple of days. But that doesn’t reduce their parents’ level of anxiety.

It’s not enough for us to provide expert care. We also serve our neighbors as caring, respectful partners in their health, offering parents frequent updates and lots of emotional support. That’s The Christiana Care Way.

In the NICU, we don’t think of parents as visitors. For as long as their babies are in the hospital, the unit is their second home, a safe and welcoming place where parents can have 24-hour access to their babies.

For years, the NICU has had a Family Council, the oldest such group at Christiana Care, in which parents and staff work together to find ways to improve the delivery of care.

In April 2012, the Patient and Family Centered Care Team was formed, bringing together many disciplines, including nurses, respiratory and physical therapists, pastoral care, front-office staff, social workers, pharmacists, neonatologists and many others.

Working together, we developed a survey to learn where we are doing well and where we need improvement. Our goal was, as The Christiana Care Way says: to develop innovative systems of care that our neighbors value.

We also got to know one another better. I believe The Christiana Care Way impacts how we treat one another

as co-workers. It is showing compassion and respect for the nurse who is crying because the baby she has cared for over many weeks has died. She is my neighbor, too.

The survey provided a platform for families to tell us what they think. We listened.

We learned that parents feel less frightened when they are true partners in taking care of their babies. So our nurses encourage moms and dads to hold their babies, even when the babies are sleeping.

Parents place a high value on information about their babies. Sometimes, we meet with parents before delivery so we can explain the issues their baby might face at birth, after delivery and after the baby goes home.

We realize that in a crisis it is difficult for loved ones to absorb information from doctors and nurses. So, we replaced our old admissions brochure with one that is more family-friendly, easy to read and answers many of their questions.

In addition, we introduced the patient care board. The board includes both the baby’s name and the name of the nurse who is caring for the baby so the parents can ask questions whenever they wish.

Putting a name to a face is a simple but powerful tool. This isn’t a baby with respiratory distress syndrome. This is Michael, a much-loved son. This is Sarah, a much-loved daughter.

Going home is a big day for families. We streamlined the discharge process so that parents can receive all the information they need in one stop. An appointment with their primary care provider already is in place. We will schedule appointments with specialists, too.

We have been tracking feedback from moms and dads since Jan. 2 and have seen a dramatic increase in patient satisfaction scores. The unit scores started in the 25th percentile. In the second quarter, the NICU overall score was in the 67th percentile. Third-quarter scores were higher still, in the 78th percentile. Scores on the likelihood of recommending our NICU are now in the 94th percentile.

We want to do even better. We will keep listening and developing new ways to better care for our tiniest neighbors and the people who love them. ●

Partnering with patients and families in the NICU is key to a healing experienceBy Carlos Duran M.D., FAAP, Chair, NICU Patient and Family Centered Care Team

6 ● F O C U S N OV E M B E R 2 0 1 3

R E S E A R C H

Christiana Care Health System is the data center and a community-based research

site in a multi-center, $20 million grant from the National Institutes of Health to support the growth of clinical and translational research. The five-year grant will support initiatives that bring research discoveries into clinical practice to meet community health needs and address health disparities.

The state of Delaware will provide an additional $5 million for the program, called Delaware CTR-ACCEL, along with $3.3 million in matching funds from the participating institutions: Christiana Care, Nemours/A.I. duPont Hospital for Children, the Medical University of South Carolina and the University of Delaware, which will lead the program.

“Christiana Care brings leadership in epidemiology, biostatistics and study design,” said William S. Weintraub, M.D., the John H. Ammon Chair of Cardiology at Christiana Care and director of the Christiana Care Center for Outcomes Research. Part of Christiana

Care’s Value Institute, the Center for Outcomes Research will manage the biostatistical and epidemiological components of the CTR program.

“As the largest provider of health care in the state, Christiana Care also brings to the program access to our patients and the intellectual capital of the many people who work here,” Dr. Weintraub said.

The executive committee of Delaware’s CTR-ACCEL is comprised of Weintraub; Thomas Buchanan, Ph.D., director of the Delaware Rehabilitation Institute; Julia Barthold, M.D., associate chief of urology at Nemours/Alfred I. duPont Hospital for Children; Steven Kautz, Ph.D., professor and chair of health sciences at the Medical University of South Carolina; and Stuart Binder-Macleod, Ph.D., associate vice provost for clinical and translational research at UD, who will serve as principal investigator.

“This important grant is instrumental in the further development of clinical and translational research in Delaware and in South Carolina, and will strengthen our

research programs so we can improve bench-to-bedside treatments,” said Weintraub. “It also will support the research infrastructure we need for the population health research we do at Christiana Care’s Value Institute.”

Among the health priorities of the CTR grant are cancer, cardiovascular disease, obesity and infant mortality.

The program includes a number of key components to support infrastructure growth, including pilot grants, mentoring, education and career development, clinical research design, recruitment of mid-career professionals and community engagement.

Michael Rosenthal, M.D., chair of the Department of Family and Community Medicine at Christiana Care, will serve as the CTR project leader for community engagement and outreach.

“Translational research is about how to take research findings and apply them to real-life situations in practices and com-munities, so community engagement is a very important component of this proj-ect,” Rosenthal said. “Many members of our practices, our providers and commu-nity members can work with us to develop research initiatives and impor-tant projects, and can help create new evidence so patients can derive the most benefit from research in health care.”

NIH awarded the CTR grant to Christiana Care and its partner institutions via the IDeA (Institutional Development Award) program, which builds research capacity in smaller states such as Delaware by supporting basic, clinical and translational research, faculty development and infrastructure improvements. ●

With $28.3 million in funding, Christiana Care Health System and partners focus on clinical and translational research

Allison K. Buonocore, M.D., meets with a patient and a family member. Primary care practices will be important partners in leveraging research to help patients.

N OV E M B E R 2 0 1 3 F O C U S ● 7

A new program for residents and fellows — LEED-R (Leadership Excellence Education – Residents/

Fellows) — aims to develop physician leaders for their current and post-training roles in the changing world of medicine, whether they remain at Christiana Care or start their careers elsewhere in the health industry.

“It is the goal of the Learning Institute Center for Transforming Leadership to implement learning programs to prepare existing and future leaders to enable transformation. This is critical for us to support Delaware’s and our country’s health care reform agenda,” said Rosa M. Colon-Kolacko, Ph.D., MBA, senior vice president, System Learning, and chief diversity officer.

“The LEED-R program is a great opportu-nity for our residents to develop as future leaders within our health care system and our community,” said Neil Jasani, M.D.,

MBA, FACEP, vice president, Academic Affairs/Emergency Medicine. “It is a unique program that sets us apart from a lot of other training sites in the arena of graduate medical education.”

Although some leading teaching hospitals engage residents in leadership development, the practice is relatively new, according to faculty members Barbara A. Monegan, director, Center for Transforming Leadership, Christiana Care Learning Institute, and Allen Friedland, M.D., program director, Combined Internal Medicine-Pediatrics Residency Program.

“Residents and fellows face increasing responsibilities and an expectation that they will work collaboratively as members of high-functioning teams and act as leaders to provide value-based care,” Monegan said. “The residents and fellows in the pilot elective were engaged and appreciative learners and are immediately applying their new skills on the job.”

CONTINUED

T H E L E A R N I N G I N S T I T U T E

The Christiana Care Way Challenge, an experiential learning game moderated by Vice President, Patient Experience Shawn Smith, MBA, encouraged teams to experience simple but profound lessons in supporting patient and family centered care. Small multidisciplinary groups collaborated to perform a simple task: In 15 minutes, build the tallest free-standing structure using 20 sticks of spaghetti, one yard of tape, one yard of string and one marshmallow, representing the patient, at the top. The exercise is modeled after The Marshmallow Challenge, designed by Tom Wujec from software firm Autodesk.

New program prepares residents and fellowsto be tomorrow’s health care leaders

8 ● F O C U S N OV E M B E R 2 0 1 3

T H E L E A R N I N G I N S T I T U T E

The first LEED-R intensive leadership development for 24 selected residents and fellows launched Sept. 9, providing two weeks of time to focus on practical knowledge, skills and attitudes that are critical to being effective leaders. The program included a leadership café that allowed residents and fellows to meet and discuss leadership in a “speed dating” format with 34 system and community leaders.

The program includes classroom delivery, e-learning, small-group work, social learning, articles and case studies, experiential learning games, mobile learning and interaction with Christiana Care leaders. The course content derives from evidence-based leadership competencies from the National Center for Healthcare Leadership and the Christiana Care Leadership Behaviors, in sync with health-system strategies.

Program objectives include developing:

• Management and leadership skills that will help prepare residents and fellows to perform their future and current roles more effectively — including communication, influence, change management and conflict management.

• Awareness of The Christiana Care Way and the leadership principles that support it.

• Competitive advantages for Christiana Care Health System in recruiting and retaining strong residents and fellows who are interested in leadership development.

• An incentive for future physician leaders to remain in the community and be active members of the clinical integrated network of Christiana Care.

In addition, participants complete a project to engage in strategically important topics such as The Christiana Care Way, health-care disparities, IT implementation and patient experience, and provide the “voice of the resident and fellow” to senior leadership.

“This program sought to bridge the gap between our clinical education and the needs of the real world, and it was a tremendous success,” said third-year radiology resident Nathan Finch, M.D. “Several new initiatives have already sprung from the two-week inaugural course; one of these is a project to initiate a series of lectures which, prior to formal training, had been going nowhere but now exceeds my initial expectations.”

The Learning Institute will report on the project three months after completion of the elective and publish findings on the initiative’s impact on skill acquisition, resident and fellow involvement in the system, physician satisfaction and retention to the health system.

“Involving residents and fellows in leadership development at an early point in their careers will help shape the future of health care. I think Christiana Care is in a great position to take the lead,” Dr. Friedland said. ●

CONTINUED

Tom Corrigan, MBA, senior vice president, finance, and chief financial officer, Mike Eppehimer, MHSA, vice president, Medicine, and Robert M. Dressler, M.D., MBA, vice chair of Medicine, joined learners for a presentation titled “Transforming from Volume to Value.”

Faculty who contributed to the inaugural LEED-R education included:

Robert J. Laskowski, M.D., MBA President and CEO, Christiana Care Health System

Janice Nevin, M.D., MPH Chief Medical Officer

Sharon Anderson, RN, BSN, MS, FACHESenior Vice President, Quality, Patient Safety and Population Health Management; Director, Center for Quality and Safety, Value Institute

Tom Corrigan, MBA Senior Vice President, Finance; Chief Financial Officer

Rosa M. Colon-Kolacko, Ph.D., MBASenior Vice President, System Learning; Executive Director, Learning Institute; Chief Diversity Officer

Edmondo Robinson, M.D.Physician-In-Chief, Wilmington Hospital; Associate Chief Medical Officer

Neil Jasani, M.D., MBA, FACEPVice President, Academic Affairs/Emergency Medicine

Shawn R. Smith, MBAVice President, Patient Experience

Virginia U. Collier, M.D., MACP Hugh R. Sharp Jr. Chair of Medicine

N OV E M B E R 2 0 1 3 F O C U S ● 9

A W A R D S & A C C O L A D E ST H E L E A R N I N G I N S T I T U T E

The LEED-R program is an elective block

available to future physician leaders who are

interested in learning leadership theory and

applicable skills. The program is targeted to

junior and senior residents and fellows at

Christiana Care, Nemours/A.I duPont Hospital

for Children and Jefferson Medical College.

The inaugural group of 24 residents and

fellows included those peer-selected by the

Christiana Care Residents’ Council, current and

rising chief residents and chief fellows,

residency and fellow representatives to the

Residents’ Council and program director or

department chair selectees.

Allen Friedland, M.D., FACP, FAAP Program Director, Combined Medicine-Pediatrics Residency Program

Brian Aboff, M.D., FACPProgram Director, Internal Medicine and Transitional Year Residency Programs; Associate Chair for Education

Mike Eppehimer, MHSAVice President, Dept. of Medicine

Robert Dressler, M.D.Vice Chair, Dept. of Medicine

Randy GaboriaultVice President, Information Technology; Chief Information Officer

Eric Jackson Jr., M.D., MBADirector, Center for Health Care Delivery Science; Associate Director, The Value Institute

Vaughn Wright, Ed.D.Director, Graduate Medical Education

Barbara Monegan, MA Director, Center for Transforming Leadership, Learning Institute

Janine Jordan, M.D. Medical Director, Care Transitions and Utilization Management, Quality and Patient Safety

Susan L. Coffey Zern, M.D. Director, Simulation Education

Mary M. Stephens, M.D., MPHDept.of Family Medicine

Sonya Wallace, M.Ed. Director, Diversity and Inclusion

Jacqueline Ortiz, M.Phil. Director, Cultural Competency

Deborah Ehrenthal, M.D. Director, Health Services Research for Women and Children, Medical Director, Women’s Health Programs, Dept. of Obstetrics and Gynecology

Omar Khan, M.D., MHS Medical Director, Eugene du Pont Preventive Medicine & Rehabilitation Institute and Community Health, Dept.of Family & Community Medicine

Carol Mostow, LICSW

Cassie A. SolomonPresident, The New Group Consulting Inc.

Jack Baroudi, Ph.D. University of Delaware

John Verdone DDI

Trudy Lonegan DDI

Lani Nelson-Zlupko, Ph.D.

Barbara Monegan, M.A., observes a team discussing possible approaches to The Christiana Care Way challenge before assembling their materials.

1 0 ● F O C U S N OV E M B E R 2 0 1 3

N U R S I N G

Data fluency helps Magnet nurses to improve patient safety

When American Nurses Credentialing Center (ANCC) appraisers visit Christiana

Care next summer to consider Magnet redesignation, the ready availability and use of data — and nurses’ ability to discuss that data and outcomes — will be paramount.

In fact, the underlying theme of Exemplary Professional Practice (EPP), the fourth model component of Magnet, is all about demonstrating outcomes, said Susan Mascioli, MS, BSN, RN, CPHQ, NEA-BC, manager, nursing quality and safety. Mascioli co-leads the EPP team in the Magnet application process.

“Christiana Care has done a lot of work around data reporting and ensuring transparency, making sure that all nurses and staff are aware of the data,” said Mascioli. A wide range of reports is readily available and updated monthly on the new Quality and Safety portal website. There, staff can find unit and team report cards, as well as compare results on key nursing indicators such as restraint use, patient falls and pressure ulcers against the National Database of Nursing Quality Indicators (NDNQI) to see whether their unit is above or below the Magnet benchmark.

“Today’s Magnet nurse needs to be aware of and able to speak to the data,” she said.

Most hospitals report data by rate, but Mascioli argues that rates don’t tell the whole story. To help match a patient with each incident, Nursing created a unique trend report that not only includes the rate, but a symbol of a patient to illustrate progress with falls, pressure ulcers and restraints. Another helpful resource is the “Christmas tree report,” on which green is good, red is

not when benchmarking against NDNQI prevalence data.

From Mascioli’s knowledge of what other Magnet facilities are using, these reports and the wealth of information they impart are unique to Christiana Care.

“These reports are very intuitive,” she said. “This is so important because units need to own and understand their data in order to figure out what their issues are and be able to fix them for performance improvement.” The reports helped medical unit 6E climb from a C-

for FY 13 to a solid B in just the first quarter of FY 14.

Falls were a significant concern for the unit, so they analyzed every occurrence to find out why their numbers were where they were.

“Three things rose to the surface,” said Constance Jordan, RN-BC, nurse manager. “We needed to improve communication among staff and with patients, we needed to perform mobility assessments on our patients, and we needed to institute hourly rounding. A real ‘ah ha!’ moment was discovering

Christiana Care nurse Eva Smith, RN, teaches a patient on 6E how to walk with a walker and move to a chair to prevent falls.

N OV E M B E R 2 0 1 3 F O C U S ● 1 1

N U R S I N G

that our patients didn’t consider themselves at risk for falls.”

The unit now holds pre-shift huddles to discuss which patients are at highest risk for falls. Patient handoff at the bedside is consistent, and the team holds in-depth conversations with patients about their fall risk.

It’s working. 6E significantly reduced the number of falls and reported falls below the Magnet mean every month from March through August. They also eliminated restraint use, reduced unit-acquired pressure ulcers and C.diff

infections, reduced their seven-day re-admission rate and improved their hand hygiene compliance, all helping the unit improve that C- to a solid B (84.1) in just the first quarter of FY 14, with plans to continue improving every month.

“These nurses truly are Magnet,” Jordan said of her team’s continuing success. “They provide excellent care based on the latest evidence, demonstrate a high level of professionalism and have one of the highest certification rates in the system. They own their practice here on 6E.”

Data-driven performance improvement resulting in improved outcomes is what a Magnet organization is all about, says Mascioli. “It can be challenging, but it’s why we’re here as Magnet nurses,” she said. “Magnet, and especially the EPP model component, is aligned with being able to speak about and show how we’re improving patient outcomes and preventing harm. It gives nurses the opportunity to own their practice by identifying areas of opportunity, addressing barriers and coming up with solutions for higher quality, safer care.” ●

PEEPS awards and workshop celebrate injury prevention

Senior Vice President and Chief Nursing Officer Diane Talarek, RN, MA, NE-BC, presented awards in October at the annual PEEPS (Patient, Environment, Equipment, Posture, Safety)Awards at Christiana Hospital to recognize Elizabeth Stone, RN, nurse manager, 6A, for continuous leadership in supporting the PEEPS program.

Six recipients were recognized for continuous efforts in supporting the PEEPS program: Rachel Clark, RN, Cardiovascular Critical Care Complex; Carolyn Gutzmirtl, RN, SDS 2C and TCU; Tony Perkins, Textile Services;

Richie Golembiewski, Guldmann Inc. ceiling-mounted lift installation; Courtney Wise, DPT, and Christina White, DPT, Rehabilitation Services.

The Wilmington ACE Unit received the team award for continuous efforts in supporting the PEEPS program.

The annual awards presentation coincides with a workshop sponsored by the PEEPS program. This year’s workshop focused on employee injury prevention when caring for the bariatric patient. ●

Christiana Care’s Compliance Hotline can be used to report a violation of any regulation, law or legal requirement as it relates to billing or documentation, 24 hours a day, 7 days a week. All reports go directly to Compliance Officer Ronald B. Sherman. Callers may remain anonymous. The toll-free number is: 877-REPORT-0 (877-737-6780).

✔ To learn more about Corporate Compliance, review the Corporate Compliance Policy online or contact Ron Sherman at 302-623-2873.

CHRISTIANA CARE COMPLIANCE HOTLINE

1 2 ● F O C U S N OV E M B E R 2 0 1 3

T H E L E A R N I N G I N S T I T U T E

16 earn Certificate in Healthcare Leadership

Sixteen managers completed Christiana Care’s 2013 Certificate in Healthcare Leadership program,

in partnership with the University of Delaware, on Nov. 5.

The nine-session, 55-hour program is an important element in Christiana Care’s commitment to develop the next genera-tion of top leaders, under the guidance of the Christiana Care Learning Institute’s Center for Transforming Leadership. Follow-up surveys of the 2012 partici-pants and their managers showed a statistically significant increase in

knowledge, confidence and application of learning.

Curriculum highlights included “Transforming Your Personal Leadership,” “Learning About Interests and Motivators, Usual Work Style, Needs and Stress Behaviors,” “Leading with Cultural Competency and Inclusion” and “Influence and Power.”

The program also included a discussion of health care reform’s implications for Christiana Care and Delaware, including a presentation by state Sen. Bethany Hall-Long, Christiana Care CFO Tom

Corrigan, MBA, and Mike Eppehimer, MHSA, vice president, Department of Medicine. Participants also received three hours of one-on-one coaching from faculty.

In addition to sessions exploring team-work as a team leader and a team member, participants worked in groups to investigate and make recommenda-tions to address some of Christiana Care’s most vexing leadership issues — meetings, succession planning, managing distractions, especially e-mail, and keeping in touch with remote teams. ●

Graduates of the 2013 Certificate in Healthcare Leadership course include: (seated, from left) Scott D. Siegel, Ph.D., psychologist, Helen F. Graham Cancer Center & Research Institute; Constance Przybylcek, RN, project manager, Nursing; Michelle Eklund, manager, Employee Relations; Joan Pirrung, APRN-BC; Melissa E. Bollinger, RN, BSN, MBA; (standing) Bonnie Osgood, RN, nurse manger, 4N; Barbara Henry, director, Medical Libraries; Allan Schwartz, Psy.D., director of Psychology; Sharon P. Lucernoni, Lab operations manager; Jennifer Rittereiser, branch manager, VNA Finance; Vaughn V. Wright, Ed.D, director, Graduate Medical Education; Courtney Crannell, RN, MSN, OCN, nurse manager, 6B; Teresa Zack, RN, nurse manager, Nursing Resources; Jeff Krebs, manager, Mechanical Engineering; and Linda Colbourne, practice manager, Christiana Care Cardiology Consultants. Absent from photo is T.J. Cournoyer, director of Major Gifts, Development Office, External Affairs.

N OV E M B E R 2 0 1 3 F O C U S ● 1 3

S W A N K M E M O R Y C A R E C E N T E R

TGIF socials at the Swank Memory Care Center help patients with memory loss to stay connected

O ne Friday a month, about a half dozen adults who are in the early stages of dementia gather at the Swank Memory Care Center to socialize, share lunch and

enjoy entertainment.

The monthly social is called TGIF because the emphasis is on getting out and having fun.

“People who have memory loss tend to become isolated, and we wanted to provide them with an activity that gets them out of the house and into a social setting,” said Mary Beth Transue, LCSW, the senior social worker who developed the program.

Innovating to provide care and services that patients value is The Christiana Care Way. In addition to her own research, Transue sought advice from an art therapist who had launched a successful social engagement program for Alzheimer’s patients in New Jersey.

TGIF entertainment for patients has included live music and singing. In the January session, an occupational therapist will offer tips on maintaining a safe home.

“We are planning on bringing in a singer who does Sinatra standards,” Transue said. “We can take a short walk outdoors and enjoy the fresh air. This is a safe place, where we want

people to feel free and enjoy themselves. Patients acknowledge that they have memory loss, but they don’t focus on it.”

Caregivers benefit from having a few hours off. “They can go to lunch with a friend or get a pedicure, the kinds of activities that many people give up when they start taking care of a loved one,” she said.

The Swank Memory Care Center is Delaware’s first comprehensive outpatient center for patients with memory disorders and their families, offering testing, support, education and guidance from diagnosis through treatment. Geriatricians, nurses, medical and administrative assistants and a social worker work closely with specialists, including neurologists and psychiatrists, to provide personalized care.

The cost of the TGIF program is $20 for each three-hour session, which runs from 10:30 a.m. to 1:30 p.m. A donation from Bank of America covers some of the expenses.

Prospective participants are evaluated to make certain the program is a good fit for their level of memory difficulty. Conditions range from mild cognitive impairment to early-stage dementia.

To learn more about the program, contact the Swank Memory Care Center at 302-320-2637. ●

Magician Steve McCormick entertains patients during a TGIF social gathering at the Swank Memory Care Center.

1 4 ● F O C U S N OV E M B E R 2 0 1 3

C H R I S T I A N A C A R E Q U A L I T Y P A R T N E R S

Christiana Care Quality Partners: Giving voice to community physicians

Concord Health Center opening soonOpening Jan. 6, the Christiana Care Concord Health Center will feature comprehensive outpatient medical services, including primary care and OB-GYN doctors; specialists in cardiology, radiation oncology, GYN oncology, dermatology and endocrinology; the region’s most trusted outpatient cancer care through Christiana Care’s Helen F. Graham Cancer Center & Research Institute; comprehensive rehabilitation services and advanced cardiovascular testing; diagnostic imaging and walk-in laboratory testing. ●

Christiana Care Quality Partners, an innovative model of health care for employees and their dependents, has formed a board of directors and is recruiting community physicians

to provide input and leadership to several committees.

“From the very beginning, private, community physicians will have a major voice in how Christiana Care Quality Partners evolves and grows,” said Doug Azar, executive director.

Currently, Quality Partners is actively recruiting community physicians in order to provide as much continuity of care as possible for employees. Azar expects to have most of those working agreements finalized by early 2014.

“We know that most employees would prefer to continue seeing their regular physicians, and we are working hard to make certain that happens well before the new plan becomes effective on July 1,” he said.

The new model for employees and their dependents focuses on making high-quality care more accessible. The goal is to enhance coordination of care and improve value for the health system, providers, and employees and their dependents.

Quality Partners also is seeking physicians to serve on five committees. Members will help shape policy and procedures for the new model. Nine physicians will be named to each committee; three employed by Christiana Care and six community physicians.

The committees are:

• Quality Improvement, which will address clinical protocol, data analytics and value-based quality metrics.

• Credentialing, which will focus on credentialing providers and provider performance expectations.

• Clinical Operations Development, which involves care and medical management programming, payer relations and network inclusion and enhancements.

• Reimbursement, which includes reimbursement philosophy and payment models.

• Governance and Leadership, which focuses on recommendations to Quality Partners’ board, committees and management.

Physicians who would like to learn more should contact Azar at doazar@christianacare.org. ●

CHRISTIANA CARE QUALITY PARTNERS

BOARD OF DIRECTORS

Quality Partners’ nine-member board includes five practicing community

physicians and four members of Christiana Care’s leadership team,

two of whom are physicians.

Alan Greenglass, M.D.

Sharon Anderson, RN

Patrick Grusenmeyer, Sc.D.

Janice E. Nevin, M.D., MPH

Kert F. Anzilotti, M.D., MBA (Radiology)

Randeep Kahlon, M.D. (Orthopaedics)

Leonard Nitowski, M.D. (Emergency Medicine)

John O’Neill, D.O., FACP (Internal Medicine)

Edward R. Sobel, D.O. (Family Medicine)

N OV E M B E R 2 0 1 3 F O C U S ● 1 5

Christiana Care helps Delawareans navigate new health care marketplace

Since the U.S. Health Insurance Marketplace opened on Oct.1, Christiana Care’s marketplace guides have been hard at work helping more than 2,000 Delawareans learn about their health-

insurance options through the Affordable Care Act and gain access to affordable health care. Christiana Care’s 12 marketplace guides are specially trained to help patients and neighbors navigate the new online marketplace, get insurance and access health services.

“The people we talk to are so glad to have someone to help walk them through their choices in the new marketplace,” said Lauren Pendergast, marketplace guide coordinator for Christiana Care. “Many have not had health insurance for a long time or have never had health insurance. Some have chronic health problems. We help them start to enroll in health insurance, identify other assistance available to them and their families and connect them with health services.”

The marketplace guides assist dozens of people every day by phone at six locations, including all three Christiana Care emergency departments and at community events. The guides set up information tables and meet with uninsured Delawareans at local churches, including Hanover Presbyterian Church in Wilmington, at local community centers and in Christiana Care’s school-based health centers.

Their work is just beginning. The Affordable Care Act requires most Americans to have health insurance starting Jan. 1, and uninsured citizens can sign up for insurance through March 31 without a penalty. More than 19,000 Delawareans are likely to enroll in health insurance during this time. Said Pendergast: “Our marketplace guides are working to reach as many of them as possible.”

Christiana Care is the only regional hospital-based health system using marketplace guides to partner in Choose Health Delaware, a state-federal partnership formed to help uninsured Delawareans learn about insurance options available to them through the Affordable Care Act.

To learn more, visit www.christianacare.org/helpwithhealthinsurance. ●

Robert J. Laskowski, M.D., MBA, president and CEO of Christiana Care Health System, welcomed nearly two dozen Delaware lawmakers and state officials to a special forum on the Affordable Care Act, Oct. 22 at the Middletown Emergency Department’s conference room.

Dr. Laskowski spoke about The Christiana Care Way and Christiana Care’s support for the principles of the Affordable Care Act.

“Making health care accessible to our neighbors is something we do every day at Christiana Care for the patients we are privileged to serve,” Dr. Laskowski said. “Helping our most vulnerable patients get health insurance is vital to our partnership with our community.” ●

Christiana Care hosts lawmakers forum on Affordable Care Act

At Wilmington Hospital Emergency Dept., marketplace guide Nancy Harman, MS, talks with patient Henry Blue Sr. about his health insurance options.

1 6 ● F O C U S N OV E M B E R 2 0 1 3

C E N T E R F O R H E A R T & V A S C U L A R H E A L T H

Blood pressure ambassadors raise awareness about hypertension in African-American community

A trained team of volunteers is spreading the word about the high risks of hypertension among African-Americans.

The Center for Heart & Vascular Health’s Blood Pressure Ambassador Program was developed to increase awareness of hypertension in the African-American community, using a model of peer education and camaraderie, said Elisabeth Bradley, APN, clinical leader of the Cardiovascular Prevention Program. Bradley and Tamekia Thomas, APN, critical care education coordinator, lead a multidisciplinary steering committee that has provided orientation, leadership, mentoring and ongoing debriefing sessions to 27 ambassadors who deliver key messages about high blood pressure and stroke to friends, family and co-workers during daily interactions.

One third of adults in the United States have hypertension, and almost that many have prehypertension. About 8 percent are undiagnosed. “It is even more common in African-Americans, who have the highest prevalence of hypertension in the world,’’ Thomas said. Compared to caucasians, African-Americans are twice as likely to have hypertension, experience a younger onset and are more likely to suffer severe organ damage or die from it.

Deniese Manuel, a blood pressure ambassador who also works in Guest Services at Christiana Care, said she speaks up at every opportunity. “Girl get-togethers, family dinners, family

friend’s funeral, I ask everybody there, do you know your numbers? Do you check your blood pressure? Some people are all into it, but a lot of my friends weren’t,’’ she said. “They didn’t know how common hypertension is in African-Americans, that it’s a silent killer. A lot of younger people didn’t think it was serious.’’

Blood pressure ambassadors receive evidence-based toolkits filled with health-promotion resources, along with networking opportunities and links to community events. The key messages, designed to be delivered in five minutes or less, inform listeners about health problems related to hypertension, including how to take action and how to recognize the signs of stroke. Ambassadors also ask key questions to encourage individuals to know their numbers, and to ensure they are connected to a health care provider.

To date, the ambassadors have reached 1,308 community members and screened 1,070 for hypertension. Sixty-four community members were referred to primary care physicians. The community events and networking opportunities are well attended and provide additional avenues for delivering the key message.

Ambassador Gloria McGillbery, a nurse in Christiana Care’s cardiac ICU, volunteers at Beautiful Gate Outreach Center, an HIV clinic in Wilmington that recently held an anniversary celebration. Six Ambassadors were on hand, she said, providing screening and information to about 200 people.

“It’s getting the message out to those in the community,’’ she said.

Most recently the ambassadors participated in the Resurrection Church health expo, delivering the key message and providing blood pressure screenings. The program has inspired the ambassadors to create additional programs in their own communities that encourage healthy lifestyles and improved awareness of hypertension.

“I talk to people about the ambassador program as part of the community, whether in barbershops, people on the corner, the

One third of adults in the United States have hypertension, and almost that many have prehypertension.

Blood Pressure Ambassador Shirley Reed-McKinney, MSN, RN, CCRN, provides a free blood pressure screening.

N OV E M B E R 2 0 1 3 F O C U S ● 1 7

C E N T E R F O R H E A R T & V A S C U L A R H E A L T H

Tobacco remains the largest preventable cause of deaths and illnesses in America, according to the American Cancer Society (ACS). Although many people have kicked the habit, one in five adults in the United States is a smoker.

Every year, on the third Thursday in November, the ACS sponsors the Great American Smokeout, challenging smokers to give up cigarettes for 24 hours.

At Christiana Care, we are committed to helping employees give up tobacco every day, not just one day a year. As leaders in health care, it’s up to us to set a positive example for our neighbors.

The truth is: Quitting is hard. No butts about it!

The good news is there are many resources for people who want to quit smoking.

You probably have heard of the nicotine patch, which releases small amounts of nicotine through the skin to ease the anxiety and restlessness of withdrawal. The patch is available over the counter. So are nicotine gum, lozenges and nasal spray.

Chantix is a prescription medication that eases nicotine withdrawal. In addition, the drug blocks the pleasurable effects of smoking, acting as a deterrent if the person who is trying to quit gets the urge to light up again.

Giving up smoking will greatly increase your odds for a long, healthy life. You will reduce your risk of lung cancer, emphysema, stroke and heart disease. Your kids will be less likely to develop ear infections and respiratory problems.

If you have tried to quit smoking before and did not succeed, don’t be too hard on yourself. A survey by the American Lung Association found that six out of 10 people who quit smoking failed at least once before they kicked the habit for good. So why not give it another try?

Christiana Care employees can receive expert, compassionate help from Employee Health. Options include face-to-face counseling and free nicotine-replacement medications for employees who need it. Ask about evening sessions that meet once a week for an hour to support employees and spouses. Call the Tobacco Cessation Hotline at 302-733-1878.

Another resource is the Delaware Quitline, a free phone counseling service provided by the state, which operates 24/7. The toll-free number is 866-409-1858.

You don’t have to go it alone. ●

C A R I N G F O R Y O U R S E L F

YMCA and wherever I go. I let my light shine,’’ said ambassador George Goldsborough. “Whatever it takes, I get the message out.’’ Goldsborough began a vigorous walking program after being diagnosed with high blood pressure. Last summer, he was approached by another walker, steering committee member Liz O’Neill, program director, Family and Community Medicine, who struck up a conversation.

“Little did I know, I was being recruited,’’ he said with a laugh. “I was doing what I love, walking and exercising.’’ He

embraced the mission. “Because of my own family history and military training, I recognize the value of good health.’’

Outreach to the community from the Blood Pressure Ambassador program aligns well with The Christiana Care Way. Ambassadors serve a valuable role in health promotion, evidenced by measurable program outcomes. In 2012, the program won the Excellence in Community Health Gold Award for Each One Reach One – Raising Blood Pressure Awareness in the African American community. ●

It’s always a good time to quit

smoking

Dept. of Medicine honors physicians for service

Christiana Care leaders honored at Black Achievers in Business and Industry Awards

At Medical Grand Rounds, Oct. 24, Virginia U. Collier, M.D., MACP, Hugh R. Sharp Jr. Chair of Medicine, presented commemorative plaques to three physicians, honoring them for outstanding service and lasting contributions: Joanne C. Brice, M.D., SFHM, chief of the Division of Hospital Medicine, 2008-2013; Anand Panwalker, M.D., chief of the Section of Infectious Diseases, 2007-2013; and Marciana Filippone, M.D., chief of the Section of Gastroenterology, 2004-2013.

Previously, Julie Silverstein, M.D., had also been recognized by her Department of Medicine faculty colleagues at the conclusion of her term as chief, Section of General Internal Medicine. ●

Dora Beckham, manager of Human Resources Operations, and Stacy N. Burwell, program coordinator for The Learning Institute/System Learning, were honored Oct. 24 during the 25th annual YMCA Black Achievers in Business and Industry Awards at the Chase Center on the Riverfront in Wilmington. Beckham and Burwell were recognized for their community involvement during the event. Actor and writer Hill Harper was the keynote speaker.

During the next year, Beckham and Burwell will mentor high school students most Saturday mornings as part of a year-long educational program at the Walnut Street YMCA. ●

1 8 ● F O C U S N OV M B E R 2 0 1 3

N OV E M B E R 2 0 1 3 F O C U S ● 1 9

I N O U R C O M M U N I T Y

Working together as expert, caring partners in the community

For more than decade, a small band of physicians — most of whom are on Christiana Care’s Medical-Dental Staff — have met each fall to share two passions: cricket and global health. The annual meeting was the brainchild of Rey Agard, M.D., and is now led by Omar A. Khan, M.D., MHS, Wasif A. Qureshi, M.D., Shakaib S. Qureshi, M.D., and private practice radiologist Tariq Quraishi, M.D. In all, 15 Christiana Care physicians and staff participated in the friendly competition that raised $4,500 this year for UNICEF to help children in Syria affected by the war. Past years’ events have raised money for Doctors Without Borders, emergency relief for Haiti and other global health causes. Photos courtesy of Mazhar Rishi, M.D. ●

At a September fundraiser for the Brain Aneurysm Foundation at BBC Tavern in Greenville, Del., neurointerventional surgeons Barbara J. Albani, M.D., and Sudhakar Satti, M.D., and Teresa Hills, ACNP, volunteered as guest bartenders and helped to raise more than $7,000 to support aneurysm education and awareness. Colleagues including Associate Chief of Neurosurgery Pawan Rastogi, M.D., and Corporate Director, Heart & Vascular Physician Practice Network Phil Chapman (shown here) joined them to show support. ●

brain aneurysm

foundation

CriCKet for

a Cause

2 0 ● F O C U S N OV E M B E R 2 0 1 3

E V E N T S

Annual event for Christiana Care Medical-Dental Staff recognizes excellence, introduces new leaders

The Christiana Care Medical-Dental Staff annual meeting, physician-created-art exhibit, dinner and presentation of the 14th Annual Commendation for

Excellence drew 350 members, spouses, friends and colleagues to Deerfield Golf Club Nov. 1.

Attendees browsed the exhibit of paintings, sculpture, photography and other artwork by 15 physician-artists before filing into the ballroom for official business, including new officer announcements, a feast and annual awards ceremonies.

Immediate past-president Eric Johnson, M.D., new president Brian Burgess, M.D., and Robert J. Laskowski, M.D., president and CEO of Christiana Care, welcomed the M-D Staff members and guests before starting an evening agenda that included: presentation of nine Rising Star Awards; the Commendation for Excellence Award; special awards for teaching excellence from the departments of Medicine, Surgery, Hospital Dentistry and Maxillofacial Surgery, Obstetrics and Gynecology, and Radiology; and recognition of individuals and one group practice having received awards or appointments that are national in scope. ●

Joe Lex, M.D., FACEP, MAAEM, professor of Clinical Emergency Medicine at Temple University School of Medicine, gave a lecture titled “Medical Aspects in the Care of Gunshot Wounds Suffered by President John F. Kennedy on Nov. 22, 1963.”

Ehsanur Rahman, M.D., receives Commendation for Excellence

The 2013 Commendation for Excellence — awarded for “clinical care and compassion, education and leadership” — was presented to Ehsanur Rahman, M.D.

Dr. Rahman started blazing a trail of excellence in the Department of Medicine and the Division of Cardiology 33 years ago as a leading clinician, teacher and researcher. His impact on the training of many Christiana Care medical residents and cardiology fellows has earned four Department of Medicine Teacher of the Year Awards — more than anyone else in the department’s history. He has received three consecutive Christiana Care Cardiology Fellowship Teacher of the Year awards, and that award is now named after him.

His friend and colleague for many years has been the Medical-Dental Staff’s departing past president, Anand Panwalker, M.D., who nominated Dr. Rahman for the Commendation: “Possessing exceptional powers of persuasion, Dr. Rahman teaches that clinical excellence does not have to be expensive or overwhelmed by technology.

Brian E. Burgess, M.D., from the Department of Emergency Medicine, begins a two-year term as president of Christiana Care’s Medical-Dental Staff.

N OV E M B E R 2 0 1 3 F O C U S ● 2 1

E V E N T S

Ehsanur Rahman, M.D., receives Commendation for Excellence

He steadfastly opposes waste and lapses in critical thinking in the medical profession, and he has taught that health care is best when it is always value-based, incorporating cost control, quality and safety for many years before these virtues became popular. His great integrity and high principles focus above all else on ensuring that his patients are safe and receiving the best quality care.”

He is invited consistently to present at the annual Department of Medicine Clinical Pearls program — a popular medical grand rounds started in May 2002 where the best teachers, selected by Christiana Care house staff, are given the honor of delivering words of wisdom to residents and staff as the academic year winds down.

Dr. Rahman received his degree in medicine (M.B.) from Dhaka Medical College, Dhaka, Bangladesh. He trained in internal medicine at St. Joseph Mercy Hospital in Pontiac,

Mich. He was a fellow in cardiology at St. Joseph and at Mount Sinai Medical Center in Miami Beach, Fla.

He has served as president of the Delaware Affiliate of the American Heart Association and governor of the Delaware Chapter of the American College of Cardiology.

Dr. Rahman is a member of Cardiology Physicians, P.A., and a clinical assistant professor of medicine at Thomas Jefferson University. He is board-certified in internal medicine, cardiovascular diseases, interventional cardiology and critical-care medicine.

Dr. Rahman’s spirituality and humanity instills in him a strong faith and a generous heart, friends say. He is involved in international projects to help medically needy populations, including a general-practice clinic in Bangladesh. He is also a great story teller known for his fine sense of humor. ●

6th Annual Delaware Orthopaedic Symposium

The 6th annual Delaware Orthopaedic Symposium in October at the John H. Ammon Medical Education Center featured two keynote speeches on the latest advancements in musculoskeletal health and orthopaedic surgery: “The Shock Trauma Approach” by Andrew Pollack, M.D., and “The Future of Private Practice” by Jack Bert, M.D. The symposium included 12 talks organized into orthopaedic surgery, primary care orthopaedic medicine and rheumatology tracks. ●

Front: Carlose Rose, M.D., Paul Rosen, M.D., Arundathi Jayatilleke, M.D., Andrew N. Pollak, M.D., Jack Bert, M.D., Elliott Leitman, M.D.

Back: Randeep Kahlon, M.D., Linsey O’Donnell, D.O., Matt Handling, M.D., Damian Andrisani, M.D., Christine Baugh, MPH, Eric Russell, D.O., Thomas Fleeter, M.D., Brian Galinat, M.D.

Ehsanur Rahman, M.D., a member of Christiana Care’s Department of Medicine, Cardiology Division, for 33 years, received the 14th Annual Christiana Care Medical-Dental Staff Commendation for Excellence, presented by his longtime friend and colleague Anand Panwalker, M.D.

Kidney Transplant Symposium outlines phases of transplant process

The 4th annual Kidney Transplant Symposium for Nurses and Dialysis Technicians in October provided a full day of learning on the transplant process. This year’s symposium examined topics including racial disparity in kidney disease, drug therapy and ethical dilemmas in transplant. S. John Swanson, M.D., chief of transplant surgery, explained the signs, symptoms and treatment of rejection. ●

S. John Swanson, M.D.

Employees representing India wore colorful, traditional costumes at the Cultural Talks session.

2 2 ● F O C U S N OV E M B E R 2 0 1 3

E V E N T S

The Christiana Care Learning Institute Center for Diversity & Inclusion, Cultural Competence and Equity sponsored a Cultural Talks session Oct. 21 at the John H. Ammon Medical Education Center, focusing on Southeast Asia. The talks are educational dialogues organized to provide opportunities for colleagues to learn more about the diverse cultural values and perspectives that exist within the workplace and among the patients and families that we serve. The sessions help Christiana Care build cultural competency and promote respectful encounters. ●

Did you know

Christiana Care’s Kidney Transplant Program opened a second office in Lewes, Del., and began seeing patients in September. This makes care more convenient for pre-transplant patients, which improves engagement and appointment adherence, and reduces time and costs of transportation. The Kidney Transplant Program will expand this service to post-transplant patients in 2014.

Learning Institute Cultural Talks focus on Southeast Asia

S. John Swanson, M.D.

N OV E M B E R 2 0 1 3 F O C U S ● 2 3

E V E N T S

Christiana Care partners with local business in cancer prevention event for Latinas

Spanish conversation filled the conference rooms of the Helen F. Graham Cancer Center & Research

Institute on a recent Saturday, as more than 80 people, employees of Elite Building Services and their friends and family, gathered to learn in their own language about cancer prevention.

Elite provides housekeeping services to several buildings at Christiana Care, and many of the employees speak Spanish as their first language. They spent the morning at the Cancer Center learning about breast and cervical cancer, the role of genetics, risk factors, cancer symptoms and other health information. Thirty-nine women received mammo-grams, most paid for by Susan G. Komen Philadelphia, and 52 attendees were given combination screening for glucose, cholesterol and blood pressure, and cancer risk assessment.

“We are so excited about the turnout,’’ which exceeded expectations, said Nora Katurakes, RN, MSN, OCN, manager of the Community Health Outreach & Education Department. “There is high energy and excitement. No one told them to come. They came because the message of caring for themselves was important.’’

Among those listening attentively were four members of the Figueroa family of Wilmington. The matriarch, Edna, 64, was treated at Christiana Care for breast cancer in 2005. She attended the screening event with daughters Madeline, 46, Maria, 41, and Mayte, 31. Maria is a housekeeper for Elite, and Mayte is assistant to the president.

“We came because my Mami is a cancer survivor, so we all wanted to get checked,’’ said Maria.

The sisters said they were surprised and pleased that they could turn to Christiana Care for health information and guidance in Spanish.

“I’m really happy; this is a really good opportunity for people,’’ said Madeline. In addition to mammograms, the family was able to speak with a licensed genetic counselor, Zohra Ali-Khan Catts, MS, LCGC, director, cancer genetic counseling, about the implications of their family history, what tests they need and how to mitigate their risks.

“I didn’t know they had all these interpreters here, that they had so much,’’ said Mayte Figueora. Years ago, she said, when Spanish-speaking parents needed medical help, they brought their children along to interpret. “These days, it’s much better.’

The idea for the event began just weeks earlier, when Elite’s housekeeping supervisor, Guadalupe Castañeda, went to the Breast Center for a mammogram.

“I had the opportunity to come, but I knew a lot of ladies don’t have that opportunity,’’ she said. Many Latinas

forego medical screenings because they lack insurance or lack trust in medical systems, she says. The pressures of caring for families or just not knowing where to go are also barriers. “I felt bad to think I had something they didn’t. I wanted to do something so they could also have an opportunity to have mammograms,’’ Castañeda said.

She approached Joceline Valentin, a bilingual navigator in the Community Health Outreach & Education Department, whose position is funded by a community grant from Susan G Komen Philadelphia. Together, they hatched the idea for the screening event, picked a date and, for about three weeks, communicated by desk messages — Castañeda, who works nights, left notes on Valentin’s desk for her to find in the morning, and vice versa. They created “save the date’’ cards that went out to all Elite employees inviting them to come and bring their friends. ●

“Mami” Edna Figueroa with her daughters Maria, Madeline and Mayte at the Helen F. Graham Cancer Center to participate in a special breast health and cancer prevention event for Latinas, organized by Christiana Care and Elite Building Services.

U P C O M I N G E V E N T S

2 4 ● F O C U S N OV E M B E R 2 0 1 3

Register via the Education Center. Enter Retirement Planning Seminar and choose your class. You can also call the HR Service Center at 302-327-5555 for registration assistance. Seats are limited so register today.

Nurse/Physician Partner AwardsDec. 6, 7:30a.m.,at the John H. Ammon Medical Education Center.

Throughout Christiana Care, many teams of nurses and doctors partner to improve the care we provide to our patients and our community. The Christiana Care Nurse/Physician Partner Award, the successor to the Nurse/Physician Ambassador Award, recognizes partnerships between nurses and doctors that have made an impact on the care we deliver to our patients. This recognition event honors the 2013 winning teams, nominated by their peers.

December

The Fund for Christiana Care provides quality care to our neighbors.

Annual gifts enable Christiana Care Health System to meet the most pressing needs of our patients – your friends, neighbors, and loved ones. Your generous gift to The Fund for

Christiana Care helps provide resources that make an immediate impact and allow us to provide the highest quality care for our neighbors.

Make a gift today! Visit www.christianacare.org/makeagift or contact the Development Office at 302-327-3305.

Cyd Barry, PT/MBA Clin 2 Physical Therapist for Christiana Care VNA

“I have been affiliated with the Christiana Care Visiting Nurse Association (VNA) for more than 37 years and have seen the wonderful impact the staff and their work makes on the health and lives of our clients. I know my contribution to the VNA Special Needs Fund will assist clients who are financially challenged and have no

other means of acquiring needed equipment, medications and other services.”

The best gift you can give this season is your support

Focusing on Your Financial Health SeminarsAre you looking for advice on financial planning for your retirement?

Christiana Care is offering retirement seminars to help you plan to meet your retirement goals. The one-hour sessions take place from Dec. 2 – Dec 12 at these locations:

● Christiana Hospital● Wilmington Hospital● Health Care Center at Christiana

N OV E M B E R 2 0 1 3 F O C U S ● 2 5

U P C O M I N G E V E N T S

More Events in 2014Focus on Excellence AwardsJan. 10

The 11th Annual Focus on Excellence Awards will feature keynote speaker Raymond J. Fabius, M.D., CPE, FACPE — pediatrician, founder of HealthNEXT, a company dedicated to the development of organizational cultures of health, and formerly chief medical officer of Truven Health Analytics.

Dr. Fabius has contributed to NCQA standard development for the accreditation of health plans, preferred provider organizations, disease management companies, behavioral health organizations and credentialing verification organizations. He also served as strategic adviser to the president of Walgreens Health & Wellness Division.

This year’s Focus on Excellence exhibit in October garnered 144 entries. The Focus on Excellence Awards recognize teams of employees who enter projects demonstrating improvement in process or outcomes using the PDCA (Plan-Do-Check-Act) model. If you missed the live exhibits, you can view them on the Value Institute Center for Quality & Patient Safety intranet site on the portals.

Save the Date

25th Annual Update in

CardiologyMarch 1, John H. Ammon Medical

Education Center.

2nd Annual Neurovascular SymposiumApril 11, John H. Ammon Medical Education Center.

2 6 ● F O C U S N OV E M B E R 2 0 1 3

S T A F F N E W S

Michele Campbell named vice president, Patient Safety and Accreditation

Michele Campbell, RN, MS, CPHQ, FABC, has been named vice president, Patient Safety and Accreditation.

She has been the corporate director of Patient Safety and Accreditation Services since 2008 and has held previous quality and nursing leadership positions over the past 37 years at Christiana Care.

Campbell has corporate responsibility for Christiana Care ‘s Patient Safety Program as well as ongoing Joint Commission and CMS survey readiness.

She has been instrumental in achieving annual operating goals in reducing patient harm, creating a culture of safety and leveraging technology to enhance patient safety.

She also led the successful achievement of the Gold Seal of Approval from the Joint Commission for Acute Care, Behavioral Health and Disease Specific Program Certification including the Heart Failure, Hip/Knee, Primary Stroke and Left Ventricular Device programs in collaboration with the senior leadership team. In addition, she led multiple strategic projects and successful state surveys.

Campbell completed her bachelor’s degree in nursing and a Master of Science in healthcare administration. Her strong quality and patient-safety background and experience in robust

process-improvement tools include certi-fications in Lean, Certified Professional in Healthcare Quality (CPHQ) and the Executive Fellowship from the Advisory Board Company.

She has presented nationally and region-ally and is the immediate past president of Delaware Healthcare Quality Association, a member of the National Association for Healthcare Quality and a member of the American College of Health Care Executives.

Patty Resnik promoted to vice president, Quality and Care Management

Patty Resnik, MBA, FACHE, CPHM, CPHQ, RRT, has been appointed vice president, Quality and Care Management.

Resnik started her career 22 years ago as the clinical manager in the Department of Respiratory Care. She was promoted to corporate director of Performance Improvement, Quality and Case Management in 2008.

As a vice president she will lead Christiana Care’s Utilization Management Program, transition planning, clinical registries, regulatory reporting to CMS, support for clinical service line quality efforts, development of disease-management programming through the CMMI Bridges Grant for Ischemic Heart Disease, and the continued development of population health management programming to

support the transformation of care delivery.

She earned an associate’s degree in applied science in respiratory therapy from Delaware County Community College. She is a registered respiratory therapist with a sub-specialty certification in perinatal pediatric care (RRT-NPS).

Resnik completed her Bachelor of Science in business administration and an MBA with a concentration in health care administration at Widener University.

She graduated in the inaugural class of the Executive Fellow Program at the Advisory Board Company, and she is a fellow in the American College of Healthcare Executives (FACHE).

Her professional certifications include Certified Professional in Healthcare Quality and Certified Professional in Healthcare Management. She served on the board of the Delaware Society for Respiratory Care and the state of Delaware Respiratory Care Advisory Council under the Board of Medical Practice.

Karen Toulson named director of ED clinical operations at Christiana HospitalKaren Toulson, RN, MSN, MBA, NE-BC, CEN, has been named director of clinical operations for the Christiana Hospital Emergency Department and the ED Observation Unit. Toulson received her BSN, MSN and MBA degrees from Wilmington University, an associate’s degree in business management from Goldey-Beacom College, and a nursing diploma from the Episcopal Hospital School of Nursing.

She completed the Green Belt certifica-tion program in Lean / Six Sigma from Juran in October and has earned a Certificate in Healthcare Leadership from the University of Delaware.

N OV E M B E R 2 0 1 3 F O C U S ● 2 7

Toulson holds instructor certification in BLS, PALS, ACLS and TNCC. She has 28 years of professional nursing experience over two years on a medical teaching unit and 26 years in emergency nursing. She has been the nurse manager of the Christiana ED for 14 years.

She has been published in nursing journals and textbooks and has lectured on a regional and national level on emergency nursing topics.

In her new role as director she will continue to lead the Christiana Hospital

Emergency Department and the ED Observation Unit supported by her current team of assistant nurse managers and staff.

Ryan Haydu, MBA, appointed administrative director of Kidney Transplant Program

Ryan Haydu, MBA, has been appointed administrative director of the Kidney Transplant Program. He has an extensive background in business management, leading teams to deliver high-quality solutions and workflow.

Prior to working at Christiana Care, Haydu worked in the pharmaceutical industry for 14 years in a variety of roles including sales, analytics, project management, resource allocation and business planning.

At AstraZeneca he managed a team of analysts and project managers in providing operational solutions for promotion channels. led brand and channel teams through key projects and business events in operations, brand and sales, and presented design recommendations to senior brand and sales leaders while addressing trade-offs and impacts. He received AstraZeneca’s 2012 President’s Award for his work in leading the entire sales organization through restructuring and roll-out of a customer-facing model.

Haydu received an MBA from Case Western Reserve University, a master’s degree in communication from the University of Akron, and a bachelor’s degree in communication from Youngstown State University. ●

S T A F F N E W S

Anthony L. Cucuzzella, M.D., was selected this year as the awardee from the field of Medicine at the 4th annual Arthritis Foundation Bone Bash in October at the DuPont Country Club.

After a formal introduction by his son and colleague at the Christiana Spine Center, Tony R. Cucuzzella, M.D., he was presented with an engraved plaque and recognized by all in attendance for his accomplishments.

Dr. Cucuzzella is a board-certified specialist in physical medicine and rehabilitation with a special interest in electromyography. He is also chief of the section of Physical Medicine and Rehabilitation and chairman of the Credentials Committee for the Department of Medicine. Dr. Cucuzzella is past president of the Medical Society of Delaware and has over 45 years medical career experience. He currently sees patients at the Christiana Spine Center. ●

Anthony Cucuzzella, M.D., recognized at 2013 Arthritis Foundation Bone Bash

Anthony L. Cucuzella, M.D. with Randeep Kahlon, M.D.

2 8 ● F O C U S N OV E M B E R 2 0 1 3

P U B L I S H I N G , P R E S E N T A T I O N S , A P P O I N T M E N T S & A W A R D S

PublishingDenise Lyons, MSN, GCNS, BC; Jennifer Painter, MSN, RN, OCN, AOCNS; Courtney Crannell, MSN, RN, OCN; Ruth Mooney, Ph.D., MN, RN; Linda Bucher, Ph.D., CEN, CNE; Rachel Joseph, MA, MSN, CCRN; Colleen Schwandt, RN, BSN, CRRN, RN-BC, RN II; Susan Siano, MSN, RN-BC, RN II; Barbara Marandola, MBA, RN; Stephen Keiser; Lynn Bayne Ph.D., NNP-BC, “The people in your neighborhood: Impact of Physician Cohorting on nursing units,” MEDSURG Nursing (2013), 22(5) 281 - 289.

Seema Sonnad, Ph.D., et al., “Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: A systematic review,” Journal of the American Medical Association, Dermatology, September 2013.

William S. Weintraub, M.D., et al., “Prognostic importance of coronary anatomy and left ventricular ejection fraction despite optimal therapy: Assessment of residual risk in the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation trial,” American Heart Journal, September 2013.

William S. Weintraub, M.D., Sandra Weiss, M.D., et al., “Beyond Statins: What to expect from add-on lipid regulating therapy,” European Heart Journal, September, 2013.

Anthony Sciscione, D.O., et al., Relationship between 17-alpha hydroxyprogesterone caproate concentration and spontaneous preterm birth, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and Obstetrical-Fetal Pharmacology Research Units Network, American Journal of Obstetrics & Gynecology, 2013 Oct 7.

David A. Paul, M.D., Matthew Hoffman, M.D., MPH, Robert G. Locke, D.O., MPH, et al., “Effects of

Pre-pregnancy Obesity, Race/Ethnicity and Prematurity,” Maternal Child Health Journal, 2013 Jun 26. [Epub ahead of print].

John Stefano, M.D., Robert G. Locke, D.O., MPH, Amy B. Mackley, CNS, et al., “Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure,” Journal of Perinatology, 2013 Sep 26. doi: 10.1038/jp.2013.120. [Epub ahead of print]

Presentations

Eric V. Jackson, M.D., MBA, lecture, “The Science of Safety: Creating Systems of Profound Knowledge,” Global Health Care, LLC, The Twelfth National Quality Colloquium, September, Washington, D.C.

Claudine Jurkovitz, M.D., MPH, “Decrease of Glomerular Filtration Rate at 30-day Readmission after Percutaneous Coronary Intervention,” American Society of Nephrology Meeting, November, Atlanta. Co-authors include Paul Kolm, Ph.D., Daniel Elliott, M.D., MSCE, James Bowen, B.A., and William S. Weintraub, M.D.

Abstracts accepted for presentation at the 2014 American Nurses Associations’s National Quality Conference, Feb. 5-7, 2014 in Phoenix, Ariz.:

• Kirstan Baxter, Sharmila Johnson, MSN, APN, ACNS-BC, CCRN, and Lindsay Long, RN III, CCRN “Breaking Free From Restraints.”

• Leigh Cooke, “Automating Pressure Ulcer and Restraint NDNQI Data Collection.”

• Carmen Pal, RN “Keep Patients Safe - Vaccinate.”

• Maureen Seckel, APN, ACNS-BC, CCNS, CCRN, Teresa Panchisin, APN, ACNS-BC, Dannette Mitchell, APN, ACNS-BC, CCRN, “A Nursing Collaborative: Dispelling Sacred Cows and Reducing Restraint Use.”

• Felisha E. Alderson, BSN, RN, CRRN, Sharon Kurfuerst, Ed.D, OTR/L, FAOTA, and Kathleen King, BS, RN-BC, CRRN, “It Takes a Village: An Interdisciplinary Approach to Fall Reduction Through Innovation and Practice.”

At the American Academy of Otolaryngology-Head & Neck Surgery in Vancouver in September, Robert L. Witt, M.D.

• Panel moderator, “Thyroid Surgical Care 2013: The Impact of Molecular Testing.”

• Course instructor, “Advances in the Management of Papillary Thyroid Cancer” and “Minimally Invasive Surgery for Salivary Tumors and Stones.”

Barbara Dean, RN II, “Palliative Care in Action,” the National Association of Neonatal Nurses conference, October, Nashville, Tenn.

Sarah Drummond,BS, RN, Beth Fitzgerald MSN, RN, CNOR, and Inga Sinyangwe MSN, RN, “The Great High Five: The Integration and Implementation of Aseptic Techniques in the Interventional Radiology Procedural Setting,” at the Association for Radiologic and Imaging Nursing 7th Annual Fall Symposium, September in Cincinnati.

At the October American Psychiatric Nurses Association annual conference in San Antonio:

• Peggy Mack, Ph.D., PMHCNS-BC and Margaret Bailey, MSN, RN-BC, “Moving Towards a Wellness Recovery Model of Nursing Practice.”

• Lisa Y. Mack, BSN, RN-BC, Mary M. Russell, BSN, RN-BC, and Kenneth L. Mack, BNS, RN, “Compassion Satisfaction, Burnout, and Compassion Fatigue Among Psychiatric Nurses Compared with Nurses on Other Inpatient Units in an Urban Hospital Setting.”

N OV E M B E R 2 0 1 3 F O C U S ● 2 9

E D U C A T I O N

• Margaret Bailey, MSN. RN-BC and Lisa Y. Mack, BSN, RN-BC, “New Behavioral Restraint Monitoring.”

Michael L. Spear, M.D., MSEd.L, a poster, “The Use of Role Play for Interdisciplinary Teaching of Communication Skills in Palliative Care,” the American Academy of Pediatrics National Conference and Exhibition, Section of Hospice and Palliative Care, Orlando, October.

Linda Laskowski Jones, MS, RN, ACNS-BC, CEN, FAWM, “Practicing on the Wild Side: Wilderness Wounds,” at the Lippincott’s Clinical Symposium on Advances in Skin and Wound Care, October, Orlando.

AppointmentsLauri Littleton, RN, BSN, is appointed nurse manager, 4C.

AwardsLaura Bishop, RD, of Kidney Transplant Center, received her MBA in marketing management from Wilmington University. ●

Breast Center imaging recognized as ACR Center of Excellence

The Christiana Care Breast Center at the Helen F. Graham Cancer Center & Research Institute has been designated a Breast Imaging Center of Excellence by

the American College of Radiology (ACR).

Facilities awarded the status of a Breast Imaging Center of Excellence are recognized by the ACR as having earned accreditation in all of the college’s voluntary breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program.

Breast imaging services at Christiana Care are fully accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy. Peer-review evaluations by board-certified physicians and medical physicists who are experts in the field have determined that the Christiana Care Breast Center at the Graham Cancer Center has achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs. ●

Kenneth L. Mack, BNS, RN, Lisa Y. Mack, BSN, RN-BC, and Mary M. Russell, BSN, RN-BC, presented “Compassion Satisfaction, Burnout, and Compassion Fatigue Among Psychiatric Nurses Compared with Nurses on Other Inpatient Units in an Urban Hospital Setting,” at the American Psychiatric Nurses Association annual conference in San Antonio, October.

Breast imaging services at Christiana Care are fully accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy.

3 0 ● F O C U S N OV E M B E R 2 0 1 3

Warfarin is known to interact with many medications. Some may decrease warfarin’s effects while others may increase it, hence the importance of routine INR monitoring. A significant interaction that sometimes goes unrecognized is the warfarin-amiodarone interaction.

Amiodarone inhibits the metabolism of warfarin and strongly potentiates its anticoagulation effects. In addition, the long half-life of amiodarone may possibly prolong the interaction. Clinical evidence has shown the interaction may take place over several weeks after administration. This is unique in comparison to other medications such as metronidazole (Flagyl®), fluconazole (Diflucan®), amoxicillin-clavulanate (Augmentin®), and sulfamethoxazole-trimethoprim (Bactrim®) where, in most cases, the interaction is seen fairly quickly when co-administered with warfarin.

It is recommended that a lower dosing regimen be considered when warfarin is started in patients taking amiodarone. A typical starting dose of warfarin should be reduced by 25-50%. When amiodarone is added to a stable warfarin regimen, a smaller dose reduction of 10-15% in the total weekly dose may be warranted based on the INR. These patients should also undergo more frequent INR monitoring.

With regards to INR, the typical goal should be to obtain a therapeutic INR within 4-5 days, about the time it takes to inhibit all the necessary clotting factors. Achieving therapeutic levels sooner could be the result of a drug-related interaction and holding of a dose and/or dose adjustment may be

warranted. For inpatients who are able to obtain daily labs, a good rate in climb for the INR is about 0.2 to 0.3 points per day. A faster climb could possibly lead to overshooting the goal INR. In the outpatient setting where such close monitoring is more challenging, it is recommended to check the INR daily to every other day. If this is not feasible, a weekly INR is acceptable. Once the INR is therapeutic and stable, (at least two consecutive INR levels within the goal range) the frequency of monitoring may be gradually reduced.

It is important to note that as the maintenance dose of amiodarone is adjusted, the warfarin dose will subsequently need adjusting as well. Even after amiodarone has been discontinued, the interaction can persist for several weeks due to the long half-life. More frequent monitoring should be initiated at this time as well.

The warfarin-amiodarone interaction can be misleading due to the, sometimes, slow onset. However, the interaction between the two can be quite significant. In order to minimize the risk of serious bleeding and/or clotting, INR monitoring and dose adjustments should occur more frequently with initiation and upon discontinuation of amiodarone. ●

T H E R A P E U T I C N O T E S

Spotlight on drug interactions: Warfarin (Coumadin®) and Amiodarone (Cordarone®) By Kesha Wright, PharmD

References:

Jaffer A, Bragg L. Practical Tips for Warfarin Dosing and Monitoring. Cleveland Clinic Journal of Medicine 2003; 20(4): 361-371.

Plakogiannis R, Ginzburg R. Possible Amiodarone-Warfarin Interaction: A Reemphasis on a Potentially Dangerous Drug-Drug Interaction. Journal of Pharmacy Practice 2007; 20: 469-473.

Sanoski CA, Bauman JL. Clinical Observations with the Amiodarone/Warfarin Interaction. Chest 2002; 121(1): 19-23.

N OV E M B E R 2 0 1 3 F O C U S ● 3 1

F O R M U L A R Y U P D A T E

F O R M U L A R Y U P D A T E — O C T O B E R 2 0 1 3

FORMULARY ADDITIONS

Medication – Generic/Brand Name Strength/Size Use/Indication Comment

Radium Ra 223 Dichloride Injection Xofigo

1,000 KBQ/mL6-mL vial

Treatment of bone metastases in castration-resistant prostate cancer with no known visceral metastatic disease

Administration restricted to Department of Nuclear Medicine

Etomidate 20-mL vial Etomidate 10-mL available again

Ipratropium/albuterol oral inhaler / Combivent Respimat® See interchange above

Topical thrombin 20,000-unit vial 5,000 unit vial and 20,000 unit spray remain available

THERAPEUTIC INTERCHANGE

Combivent Respimat® ● Combivent Respimat® 1 puff every 8 hrs ➜ Nebulized Duoneb® 3mL every 8 hrs

● Combivent Respimat® 1 puff every 6 hrs ➜ Nebulized Duoneb® 3mL every 6 hrs

● Combivent Respimat® 1 puff every 4 hrs ➜ Nebulized Duoneb® 3mL every 4 hrs

● Combivent Respimat® 1 puff every 8 hrs PRN ➜ Nebulized Duoneb® 3mL every 8 hrs PRN (no more than 6 doses in 24 hours)

● Combivent Respimat® 1 puff every 6 hrs PRN ➜ Nebulized Duoneb® 3mL every 6 hrs PRN (no more than 6 doses in 24 hours)

● Combivent Respimat® 1 puff every 4 hrs PRN ➜ Nebulized Duoneb® 3mL every 4 hrs PRN (no more than 6 doses in 24 hours)

FORMULARY DELETIONS

In the PinkStaff at the Christiana Care Breast Center at the Helen F. Graham Cancer Center & Research Institute wore lots of pink throughout October to promote Breast Cancer Awareness. From left: Stephanie Newill, Carol Davis, Wendy Pierce, Aldith McLarthy, Jessica Gavin, Ana Bermudez, Wendi Rader, RTRM(BS), Jennifer Cione, RTRM, Shannon Hostetter, Christina Lankford, RTRM, Tina Sterbach, Director Renie Mullaney, and Amanda Bey. ●

PRSRT STD

U.S. POSTAGE

PAID

WILMINGTON DE

PERMIT NO. 357

Christiana Care is a private, not-for-profit regional health care system that relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about our mission, please visit christianacare.org/donors.

I N T H I S I S S U E :

6 GRANT FUNDS DELAWARE RESEARCH PARTNERSHIP > $28.3 million in funding will support clinical and translational research

7 TRAINING PHYSICIAN LEADERS > LEED-R course trains residents, fellows for leadership roles

15 MARKETPLACE GUIDES > Christiana Care helps neighbors understand insurance options

External AffairsP.O. Box 1668Wilmington, DE 19899-1668www.christianacare.org

Junior Board fashion show raises $3,500 for First State School

Junior Board member Shirley Young models a fall outfit during the Junior Board fashion show and luncheon. Inset: Robert J. Laskowski, M.D., MBA,

Christiana Care president and CEO, with Junior Board President Diane Thomas, right, and Fashion Show Committee Chair Judy Legge.

r PRINTED ON RECYCLED PAPER • PLEASE RECYCLE FOCUS

The Junior Board of Christiana Care presented a fashion show luncheon in celebration of its 125th anniversary. The affair featured fall outfits from area boutiques modeled by Junior Board members, vintage clothing displays provided by members, friends and Rags to Riches Vintage Consignment shop. The exhibition included a 1938 silk/satin wedding gown, a 1930s second-wedding gown, and children’s and adult clothing and accessories from the 1890s through the early 20th century. Auctions and prizes donated by local merchants added to the excitement. The event raised $3,500 to benefit the First State School at Christiana Care, which gives children and teens with serious illnesses the chance to attend school with peers while receiving the medical treatment they need. Junior Board gifts to First State School topped $10,000 so far this year and will support educational field trips, family fun night dinners and “Bravo Bucks” positive behavior reinforcement for students. ●